5 Ideas for Reducing DME Prior Authorization Response Time

Hearing the term DME prior authorization can send shivers down the spines of physicians and healthcare professionals. If we looked up the term "prior authorization" in a dictionary, the word "burden" would appear right next to it.

DME Prior authorizations have been in place for decades, but nothing has been done to alleviate the load on doctors. According to a 2019 poll performed by the Medical Group Management Association (MGMA), 90% of responders noticed an increase in DME PA requests over the previous year. It's no wonder that DME prior authorizations are a tax on clinical resources, according to those same respondents.

Large healthcare systems around the country are working to improve their DME PA processes, which will result in considerably speedier DME prior authorizations for customers. To improve the DME prior authorization process, much of the effort is being put into documenting existing processes and applying best practices within the existing workflow.

5 Ideas for reducing DME prior authorization turnaround times: 

• Make use of online payer submission sites 

More and more payers are launching online DME prior authorization submission portals, which can reduce the time it takes to receive a DME PA to as low as 24–72 hours. Online portals enable practitioners to continuously monitor the progress of their submissions, reducing the time spent on wait with payers and perhaps reducing the total number of calls a staff member must make to the payer.

• Make full use of your EHR. 

Electronic health records (EHR) have altered clinical documentation and client encounters, but very few doctors use the capabilities in their EHR to automate their workflow. Surprisingly, even with an EHR, a majority of clinicians continue to print and file patient charts. Having both physicians and employees use their EHR capabilities properly, such as order creation and clinical documentation, can greatly reduce submission disruption and result in faster prior authorizations.

• Reduce the number of peer-reviews

Before submitting a DME prior authorization, verify that your personnel are well-versed in the numerous payer criteria. A DME PA that normally takes two business days to acquire now takes ten calendar days due to the need for peer-to-peer review. You may reduce peer-to-peer reviews and shorten approval periods by ensuring your guidelines as per the payer criteria.

• Enhance your process

Streamlining the DME PA submission process requires reducing bottlenecks in your system. Using payer portals, understanding payer criteria ahead of schedule, and submitting encounter notes within 48 hours are all changes that can be implemented to reduce bottlenecks and execute DME prior authorizations quickly.

• Make use of AI technology 

Change should not be feared. Begin using DME PA AI and benefit from the technology that may eliminate all of the superfluous manual effort associated with submitting a prior authorization. AI end-to-end solution might help you obtain faster DME prior authorizations and enhance your health system's capacity to provide accelerated, improved care.

Key Takeaways

Several clients are uninformed of the complications and length of time required to secure a DME prior authorization. Educate them with the procedure to assist alleviate the patient's resentment of the healthcare facility. 

Keep your patients informed about the prior authorization process and the implications for scheduling their operation. If supported by appropriate reasons regarding why they are waiting, they are more inclined to be patient. DME Prior Authorizations are difficult, but these tips can help.